Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study - PubMed (original) (raw)

Nutrition therapy in the intensive care unit during the COVID-19 pandemic: Findings from the ISIIC point prevalence study

Kensuke Nakamura et al. Clin Nutr. 2022 Dec.

Abstract

Background & aims: Nutrition therapy for Intensive Care Unit (ICU) patients involves complex decision-making, especially during the COVID-19 pandemic. We investigated the use of nutrition therapy in ICU patients with and without COVID-19 infections.

Methods: Nutrition therapy was evaluated during a world-wide one-day prevalence study focused on implementation of the ABCDEF bundle (A: regular pain assessment, B: both spontaneous awakening and breathing trials, C: regular sedation assessment, D: regular delirium assessment, E: early mobility and exercise, and F: family engagement and empowerment) during the COVID-19 pandemic. Basic ICU and patient demographics including nutrition therapy delivery were collected on the survey day. Physical activity for patients with and without COVID infections was categorized using the ICU mobility scale (IMS). Multivariable regression analysis of nutrition was conducted using ICU parameters.

Results: The survey included 627 non-COVID and 602 COVID patients. A higher proportion of COVID-19 patients received energy ≥20 kcal/kg/day (55% vs. 45%; p = 0.0007) and protein ≥1.2 g/kg/day (45% vs. 35%; p = 0.0011) compared to non-COVID patients. Enteral nutrition was provided to most COVID patients even with prone positioning (91%). Despite nutrition therapy, IMS was extremely low in both groups; median IMS was 1 in non-COVID patients and 0 in COVID patients. The rate of energy delivery ≥20 kcal/kg/day was significantly higher in patients with COVID-19 infections in the subgroup of ICU days ≤5 days and IMS ≤2. Having a dedicated ICU nutritionist/dietitian was significantly associated with appropriate energy delivery in patients both with and without COVID-19 infections, but not with protein delivery.

Conclusion: During the COVID-19 pandemic, patients with COVID-19 infections received higher energy and protein delivery. Generally low mobility levels highlight the need to optimize early mobilization with nutrition therapy in all ICU patients.

Keywords: COVID-19; Critical care; Energy; Mobility; Nutrition; Protein.

Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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Figures

Fig. 1

Fig. 1

Rate of energy delivery ≥20 kcal/kg/day according to intensive care unit (ICU) days and ICU Mobility scale. The rate of energy delivery ≥20 kcal/kg/day contrasting to ICU days and IMS is shown. The bars in front side represent the nutrition therapy in whom physical activity was low. The patients with COVID-19 infections received adequate energy delivery more frequently with lower physical activity in early acute phase than those without COVID-19 infections, both in overall and in mechanically ventilated. A: energy delivery in the non-COVID group, B: energy delivery in the COVID group, C: energy delivery in mechanically ventilated non-COVID, D: energy delivery in mechanically ventilated COVID. ICU, intensive care units; IMS, ICU mobility scale; COVID, coronavirus disease.

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